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  • Cauda Equina Syndrome for lumbar disc disease--- timing of surgery has no influence on the outcome

    Final Number:

    Rajesh Kumar Barooah; Basanta Baishya MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Cauda equina syndrome (CES) is a complex of clinical symptoms/signs secondary to prolapsed intervertebral disc presenting with varying combinations of lower extremity weakness, sensory loss and/or saddle area, pain in the low back and/or lower extremities, and visceral impairment of bladder, rectal and/or sexual function and in the literature the term “cauda equine syndrome” means a syndrome that includes impairment of urinary function and saddle sensory deficits.

    Methods: We have taken all the discogenic CES cases that presented to the Department of Neurosurgery at Gauhati Medical College & Hospital from Jan 2010 to Dec 2011. All the patients were subjected to thorough evaluation clinical/radiological and all underwent surgery followed by analysis of the surgical outcome.

    Results: Of the total of 30 patients , male outnumber female , maximum incidence being 4th decade. Clinically patients presented with history of recent onset and an earlier less well defined history of pre existing symptoms. Low back ache being the most common symptoms and urinary straining/retention was the most common autonomic disturbance. Urinary function outcome was poor in 2 pts, fair 10 pts, normal 18 pts. Time interval to surgery after autonomic involvement range from 5 days-240 days. The most common level was L4-5 followed by L5-S1, laminectomy single level done in 17 cases followed by discectomy

    Conclusions: Surgical intervention should be done in CES irrespective of the duration and severity of clinical symptom and autonomic symptoms. Timing of surgical intervention from autonomic involvement does not affect outcome. It is the severity of deficit which is the major determinant of outcome.

    Patient Care: Probably it will through some light on the ongoing debate on the outcome of surgery between those who present early and those who present late after autonomic involvement.

    Learning Objectives: It is the severity and not the timing which determine the outcome.


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